Addictions News Now: Current Issue
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March 2010
The literature regarding the interaction between Substance Use Disorders (SUDs) and health conditions is growing. A new report from the National Council for Community Behavioral Healthcare titled Substance Use Disorders and the Person-Centered Healthcare Home, describes the features of the patient centered medical home (PCMH) and discusses evolving evidence, experience, and approaches to incorporating substance use treatment services into this model. Behavioral health—and more specifically, substance use screening and brief treatment—must be fully incorporated into the PCMH in order to successfully meet the needs of those with substance use disorders.
With the passage of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and continued Congressional efforts to pass substantive healthcare reform, behavioral health has come of age and is indeed being viewed as fundamental to good general health. These accomplishments signify that national policymakers understand the importance of the early identification and treatment of substance use and mental disorders. We must continue to be vigilant however, to ensure that evolving payment and delivery system reforms like the PCMH incorporate behavioral health in every level of design and implementation.
Therefore, this new report from the National Council is intended to be used in national, state and local dialogues regarding the PCMH—to bring the relevance of MH/SU treatment into those discussions and to support the resolution of potential barriers. The promise of the PCMH can only be fully realized if it becomes the person-centered healthcare home, with MH/SU capacity fully embedded in primary care teams and primary care capacity embedded in MH/SU teams.
The full report is available on the National Council's web site.
ON THE HILL
National Advocates Make Requests for FY 2011 Appropriations for Substance Use Prevention & Treatment Services
Following President Obama’s budget requests for Fiscal Year 2011, which include several increases for substance abuse treatment services, national advocates have made their “field request” for the FY 2011 budget, detailing our request for additional funding for key substance use prevention and treatment services:
- Substance Abuse Prevention and Treatment Block Grant: $210 million increase to the President’s request of $1.8 billion
- Center for Substance Abuse Treatment Programs of Regional and National Significance: $42.6 million increase to the President’s request of $487 million
- Center for Substance Abuse Prevention Programs of Regional and National Significance: $54.2 million increase to the President’s request of $223 million
- National Institute on Drug Abuse: $103.6 million increase to the President’s request of $1.1 billion
- National Institute on Alcohol Abuse and Alcoholism: $47.4 million increase to the President’s request of $475 million
For additional information on the proposed appropriations levels for substance use and addictions programs, see the February issue of Addictions News Now.
Earlier this week, the Senate voted 62-36 in favor of extending the Federal Medical Assistance Percentage (FMAP) increase for an additional six months, to June 30, 2011. The FMAP increase, originally enacted in the 2009 economic recovery bill, provides fiscal relief to states by increasing the federal share of support for states’ Medicaid programs through Dec. 30, 2010.
The extension of the FMAP increase, which was included in legislation to extend certain tax breaks, must now be approved by the House before it can be sent to President Obama for his signature. The House has twice already voted to pass the FMAP extension: once as part of its original jobs bill, and once as part of its version of healthcare reform. While some members of the House have expressed concerns about the cost offsets included in the Senate-passed bill, we do not foresee any major obstacles that would prevent passage of the FMAP extension.
The National Council would like to thank our members who responded to our many Action Alerts in support of the FMAP extension. Your strong and consistent advocacy had a direct impact on the bipartisan Senate vote for the bill! Here is what you did that made such a difference:
- Sent nearly 1,500 messages to your Senators in support of the FMAP increase
- Contributed to the hundreds of signatures on a sign-on letter from organizations around the country
- Participated in targeted outreach to key members of Congress on the committees with jurisdiction over Medicaid
- Shared your personal stories about how a failure to enact the FMAP increase would impact your states and communities
- Supported or attended the National Council/NASMHPD Congressional briefing on the public mental health funding crisis, where our requests for Congress included the FMAP extension
Thank you for your consistent and powerful advocacy in support of extending the FMAP increase! Stay tuned to the Public Policy Update and our Action Alerts for information on the bill's progress through the House and opportunities to get involved.
The Centers for Medicare and Medicaid Services announced on Feb. 26th that twelve states will receive federal matching funds for the state planning activities necessary to implement the electronic health record (EHR) incentive program established by the American Recovery and Reinvestment Act of 2009 (ARRA). Under ARRA, states may receive matching funds of 90% after receiving approval from CMS for their implementation planning proposals. These federal matching funds are separate from the actual EHR incentive payments that will be made to providers under the incentive program. The twelve states are: Alabama ($269,000); Arkansas ($815,000); Arizona ($2.89 million); Florida ($1.69 million); Illinois ($2.18 million); Kansas ($1.70 million); Maine ($1.40 million); Michigan ($1.52 million); Nebraska ($894,000); Oklahoma ($587,000); Vermont ($294,000); and Virginia ($1.66 million). CMS will continue to award matching funds to additional states on a rolling basis. Press releases for each state can be found on the CMS website.
The entire House and one-third of the Senate are up for re-election in 2010, and a recent spate of retirement announcements has added new uncertainty to the outcomes of the elections and the future of many federal MH/SUD policy issues. In this competitive political environment, there’s no better time to increase your political engagement. Join us for the National Council’s 6th Annual Public Policy Institute and Hill Day on June 29-30 and leverage your political influence by making your voice heard at this crucial time in the midterm election cycle. In addition to meeting with your state and federal elected officials, the 2010 Public Policy Institute and Hill Day will give you the opportunity to learn the most up-to-date information about the 2010 elections. The National Council has invited members of the Obama administration, key congressional staff, and political analysts to speak to you about the current political climate and help you align your message with anticipated political events in 2010. Stay tuned to the Hill Day page of our website for the latest information about speakers, presentations, and the schedule of events.
Registration for Hill Day is free and open to all members. Register today, and start setting up your June 30th appointments with your Senators, Representative, and the Washington branch of your Governor’s office!
IN THE NEWS
In a report submitted to the House Committee on Veterans’ Affairs, Subcommittee on Health, the Government Accountability Office (GAO) finds that while the Dept. of Veterans’ Affairs (VA) continues to face challenges in providing substance use disorder services, it is making efforts to improve the availability and quality of these services to veterans. GAO identified several factors that currently challenge the ability of veterans to access SUDs services including lack of appropriate staff at VA locations. Meanwhile, efforts that are underway to increase the number of facilities that can provide SUDs services, encourage the use of evidence-based practices, and monitor treatment outcomes are cited as clear strategies to improve the situation.
The Administration on Children and Families (ACF) Office of Family Assistance has provided information on how State Maintenance-of-Effort (MOE) funds may be used to pay for emergency addiction services for families in need. Although MOE funds may not be commingled with emergency TANF funds to provide medical treatment, many addiction services are non-medical in nature. Detailed guidance is available from ACF.
Gen. Peter Chiarelli, the Army’s second-in-command officer, has called on the Army to hire 300 new substance abuse counselors to meet the high levels of need among active-duty members and veterans. In 2009, the number of soldiers seeking alcohol abuse treatment rose to 9,199, a 56% increase over the number seeking treatment at the start of the Iraq war in 2003. Currently, the Army operates a program at three centers where soldiers can seek treatment off post, during nights and weekends, without their commanders being notified. Additional substance abuse counselors would be needed to expand the program throughout the Army and reach the target goal of one counselor for every 1600 soldiers.
The California Department of Corrections and Rehabilitation (DCR) has launched an initiative to increase access to trauma-informed substance abuse treatment for incarcerated women. Three prison facilities have opened programs, with each serving 175 female offenders. The programs are designed to assist women with overcoming the underlying causes of addiction while preventing relapse and recidivism. Although the treatment model was originally intended to extend for 6-36 months, due to budget constraints, the programs will now provide women with 90-day courses of treatment.
The New Mexico House last month approved a bill that would allow judges to sentence certain drug offenders to substance abuse treatment rather than jail. The Substance Abuse and Crime Prevention Act would require the offenders to pay for treatment, but allows the state to pursue the original charges if the treatment is not completed. On first consideration of the bill, the House voted 37-33 against it; however, proponents of the bill persuaded the chamber to reconsider it two days later, and it won approval on a 34-31 vote.
The Wisconsin State Senate has voted to approve a bill that would require health insurers to cover addictions treatment and mental health services at an equal level with medical and surgical benefits. The bill would close a loophole in current federal law by requiring parity to apply to nearly all group health insurance plans, including those of 50 or fewer employees. A similar bill has already been approved by the Assembly Committee on Health and Healthcare Reform.
RESOURCES & REMINDERS
Regulations providing guidance on how insurance plans should implement the Wellstone-Domenici Parity Law were issued on Jan. 29, 2010. These regulations will go into effect for plan years that begin on July 1, 2010 or later. Up until that time, insurance plans are expected to make a reasonable effort to comply with the terms of the law.
The National Council wants to make sure that group health plans covered by the law are complying with its requirements. If you suspect that your insurance plan is improperly restricting coverage of substance use disorder services, we want to hear from you. Your stories will help us monitor the implementation of the law and identify critical concerns or patterns across the country. Click here to send us an email about whether the parity law is working for you. In particular, we'd like to hear about any specific problems you're experiencing in getting coverage for substance use treatment, or whether your insurance plan has dropped mental health/substance use coverage that it previously offered.
For more resources on the Wellstone-Domenici Parity Law and for information on how to file an official complaint with the Department of Health and Human Services or the Department of Labor, visit the Parity page of our website.
The National Council is part of the Parity Implementation Coalition, a group of addictions and mental health organizations formed to keep the implementation of the Wellstone-Domenici Parity Act consistent with Congressional intent and ensure that robust addictions and mental health benefits are available to Americans covered by the parity law. The coalition will be releasing a detailed legal analysis of the parity regulations sometime in the next two weeks. Stay tuned to the Public Policy Update for more details.
National Council Makes Recording of Webinar and FAQs on Proposed Health IT “Meaningful Use” Guidelines Available on Website
On Jan. 13, the Centers for Medicare and Medicaid Services released its proposed criteria for establishing “meaningful use” of electronic health records. Compliance with these standards will be required for providers or health organizations hoping to take advantage of the health information technology incentive payments established by the American Recovery and Reinvestment Act of 2009. The National Council hosted a webinar on Feb. 19th during which we reviewed the major components of the proposed criteria, discussed how the rules can be applied to community behavioral healthcare organizations, and shared with you for feedback, and our initial comments on the criteria. As a follow-up from this webinar, the National Council prepared a Frequently Asked Questions document, which will be regularly updated as we receive questions about the proposed rule. You can access a recording of the webinar, as well as the FAQ document, on our website.
The Department of Education is now accepting applications for $875,000 in grants to support alcohol and other drug abuse prevention programs on college campuses. Up to six grants of $137,500 each will be awarded. Eligible applicants are institutions of higher education with alcohol or drug prevention programs that have already been in place for at least two years. The application deadline is Mar. 31, 2010.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced it is now accepting applications for its Drug Free Communities Mentoring Program. A total of $1.1 million is available for 15 grants of up to $75,000 each. Eligible applicants are current Drug-Free Communities (DFC) grantees; grants will be used for mentoring and supporting newly-formed or developing coalitions that have never received a DFC grant. The application deadline is Apr. 23, 2010.
A new SAMHSA report using data from the National Survey on Drug Use and Health found that about 3 million uninsured workers, or 16.3%, had a need for substance abuse treatment in the previous year. However, only 12.6% of those who required treatment actually received it at a specialized facility. Moreover, 80% of workers who were identified by researchers as having a treatment need said they did not believe they needed treatment. The full report is available online.
The National Institute on Drug Abuse (NIDA) will hold its 2010 conference Blending Addiction Science and Practice: Evidence-Based Treatment and Prevention in Diverse Populations and Settings on Apr. 22-23 in Albuquerque, New Mexico. The conference will feature presentations on promising new treatments, substance use among high risk adolescents, veterans’ issues and substance use disorders, treatment through the criminal justice system , evidence-based practices for women, smoking prevention and early intervention, and much more. See the NIDA conference newsletter for additional details.
